title: Vascular effects of nonsteroidal antiinflammatory drugs.
abstract: The effect of nonsteroidal antiinflammatory drugs (NSAIDs) on the risk of cardiovascular events remains controversial. Among NSAIDs, only low-dose aspirin exerts protective vascular effects. Low-dose aspirin has been proven effective for secondary prevention. For primary prevention, the usefulness of low-dose aspirin is debated, as illustrated by the differences in recommendations across countries. NSAIDs other than aspirin, whether COX-2 selective or nonselective, increase the risk of cardiovascular events. Among them, naproxen is associated with the smallest risk increase. In patients with a history of coronary artery disease, diclofenac seems to carry the greatest risk, but all NSAIDs should be avoided. Uncertainties persist about aspirin interactions with other NSAIDs and with proton pump inhibitors. An adverse effect of acetaminophen on the risk of cardiovascular disease cannot be completely ruled out.
authors.affiliation: Service de rhumatologie, hôpital G.-Montpied, BP 69, 63003 Clermont-Ferrand, France. msoubrier@chu-clermontferrand.fr
authors.forename: Martin
authors.initials: M
authors.lastname: Soubrier
authors.forename: David
authors.initials: D
authors.lastname: Rosenbaum
authors.forename: Zuzana
authors.initials: Z
authors.lastname: Tatar
authors.forename: Clément
authors.initials: C
authors.lastname: Lahaye
authors.forename: Jean-Jacques
authors.initials: JJ
authors.lastname: Dubost
authors.forename: Sylvain
authors.initials: S
authors.lastname: Mathieu
mesh_terms: D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects*; D001241:Aspirin / Q000009:adverse effects*; D002318:Cardiovascular Diseases / Q000453:epidemiology*; D004008:Diclofenac / Q000009:adverse effects; D006801:Humans; D009288:Naproxen / Q000009:adverse effects; D011322:Primary Prevention; D012307:Risk Factors; D055502:Secondary Prevention
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D004008:Diclofenac; D009288:Naproxen; D001241:Aspirin
keywords: Acetaminophen; Aspirin; Cardiovascular death; Myocardial infarction; Nonsteroidal antiinflammatory drugs; Stroke